Understanding the Relationship Between Mental Health and Substance Use

Did you know that many people face both mental health challenges and substance use issues at the same time? In fact, the two are closely related and often overlap.

While society has come a long way in understanding and accepting mental health struggles, struggling with substance use or having a substance use disorder, still carries a lot of stigma. However, it’s important to address both of these challenges, and recognize the complex connection between them. If you or someone you know is dealing with mental health or substance use difficulties, gaining a better understanding of the interrelationship can make all the difference.

So how exactly are they related? Research has shown that people with mental health disorders are more likely to develop substance use disorders, and the reverse is also true. This means that treating one condition without addressing the other can be challenging and ineffective. Here are some important factors to consider when learning about mental health and substance use:

  • At least 20% of people with mental illness experience substance use issues, compared to around 8% of the general population.
  • People with schizophrenia are particularly vulnerable to substance use disorders, with a likelihood as high as 50%.
  • Substance use disorders are up to three times more common among people with mental illness than in the general population.
  • Nearly 50% of people with severe mental illness also experience a substance use disorder.
    People with Anxiety Disorder are twice as likely to have Substance Use Disorder compared to those without diagnosed Anxiety Disorder.
  • Depression and substance use have a reciprocal relationship, meaning each can contribute to the other’s onset or worsening.
  • Substance use can mask the symptoms of mental illness, making it difficult to diagnose and treat both conditions effectively.

Both mental illness and substance use are impacted by various risk factors which include biology, environment, and experiences. You may have heard this talked about as the biopsychosocial model. Examples of factors that can increase someone’s risk of mental health and substance use issues include adverse childhood experiences, traumatic events, family genetics, environmental factors, and neurobiology (e.g., neurotransmitter deficits). None of these factors cause mental health or substance use issues alone, but the more risk factors someone has, the more likely they are to experience challenges. Spiritual factors also play a role in terms of someone feeling a sense of purpose, meaning, and connection in their life.

According to the Substance Abuse and Mental Health Services Administration, nearly 9 million people in the United States have a co-occurring disorder, but only 7% receive treatment for both conditions, and nearly 60% receive no treatment at all. This is a significant problem that highlights the need for more comprehensive and accessible treatment options.

CBT for mental health and substance use challenges

One treatment that has been shown to be an effective tool for both mental health disorders and substance use disorders is Cognitive Behavioral Therapy (CBT). CBT is a therapeutic technique based on the fact that our thoughts, feelings, and behaviors are interconnected, and that changing one element of the system can lead to positive changes in the others.

One technique used in CBT is to identify thought distortions, aka unhelpful thought patterns, and to learn how to reframe them. This technique can help people build resilience and develop healthier coping mechanisms. One example of a thought distortion is overgeneralization. Someone trying to change their substance use may think, “I’ve failed once, so I’ll fail again.” This is an unhelpful thought distortion that may keep someone from learning from mistakes and moving forward. Another example of a thought distortion is called discounting the positive. This might look like only focusing on what we see as negative in our life rather than being encouraged by what is going well.

The “multi-tool” approach to treatment

While CBT has been shown to be effective as one way to work through mental health or substance use challenges, it’s important to note that there is no one-size-fits-all approach to treatment. Different people may respond better to different therapies or combinations of therapies.

Navigating mental health and substance use can feel like hiking through rugged terrain. You need the right tools and preparation to tackle the challenges ahead. Just as a hiker would bring a detailed map, trail journal, and sturdy boots, someone facing mental health and substance use challenges may need a variety of tools and resources.

These tools may include a support group to hike alongside you, providing encouragement and camaraderie. Just as a hiker may take breaks to rest and recharge, it’s important to allow yourself time to take care of your mental and physical health.

As with any challenging hike, it’s also helpful to have an experienced guide who knows the terrain well. A mental health or substance use professional can serve as that guide, providing knowledge and expertise to help navigate the twists and turns of mental health and substance use issues. They might introduce you to a number of techniques to add to your toolbelt, such as Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), Acceptance and Commitment Therapy (ACT), and more. With the right tools and support, you can better navigate the rugged terrain of mental health and substance use challenges.

ALAViDA offers tools to help you change your relationship with substances.

If you’re looking to make changes to your substance use behavior, ALAViDA can offer the help you need. Our iCBT modules (internet-based Cognitive Behavioral Therapy) are one of the primary support options we provide, along with coaching and resources available through the TRAiL platform. In addition to iCBT, we offer notifications and tracking tools to keep you on track, and optional group coaching to help you connect with others who are also working towards their goals. Together, these resources can help you change your relationship with alcohol and other substances and make lasting improvements to your mental health and well-being. Click here to sign up or login to the ALAViDA TRAiL.




Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.